优先性、伦理原则与稀缺医疗资源分配

Priority,Ethical Principle,and Allocation of Scarce Medical Resources

针对稀缺医疗资源分配问题,伊曼纽尔等学者主张将资源分配的优先级依次赋予生命能够得到最大化拯救和延长的人、能够带来最大工具性价值的人以及境况最差者,对其他社会成员的救助,则采取同等条件下的随机选择机制。遵循罗尔斯式的词典式排序规则,该优先性安排要求将功利原则置于平等原则之前,使工具性差别原则、整体性差别原则以及机会公平平等原则依次作用于特定的分配对象。该伦理价值框架及其优先性规则,尽管在面临医疗挤兑等困境时弊端突显,但是,通过对其内在结构的剖析,有助于回应稀缺医疗资源分配中的四个核心问题。

Aiming at the allocation of scarce medical resources,Immanuel and other scholars have put forward a set of influential ethical values and guiding principles.It assigns the priority of resource allocation to those whose lives can be saved and maximized,those who can bring the greatest instrumental value,and those who are the worse off.For other members of society,random selection under the same conditions is adopted.Following the Rawlsian“lexical order,lexicographical”rule,this priority arrangement requires that the“utilitarian principle”should be placed before the“equality principle”,and the“instrumental difference principle”,the“integrity difference principle”and the“fair opportunity principle”in turn acts on specific distribution agents.Although the framework and its priority rules have obvious drawbacks when faced with Medical Resources Squeeze and other dilemmas,with the help of an understanding of its internal structure,it can effectively respond to the four core issues in the allocation of scarce medical resources.